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[基于床边超声波的败血性右室功能障碍的预后评估和风险因素分析]

Heqiang Li¹, Yanping Xu², Xiaoya Zhang³

¹The First Clinical Medicine School of Ningxia Medical University, Yinchuan 750004, China.

Zhonghua wei zhong bing ji jiu yi xue

|September 29, 2025

概括

败血性右心室功能障碍 (SRVD) 在败血症患者中很常见,并且与更糟糕的结果有关. 左下心室喷射分数 (LVEF),血小板计数 (PLT),血清肌素 (SCr) 的升高,以及上腺素的使用独立地预测SRVD风险.

科学领域:

临界护理医学临界护理医学
心脏病学心脏病学
重症监护病房 (ICU) 管理管理

背景情况:

败血症可能导致多器官功能障碍,包括心脏.
在败血症中,右心室功能障碍 (RVD) 与预后不佳有关.
早期识别和对性右心室功能障碍 (SRVD) 的风险分层对于患者管理至关重要.

研究的目的:

用床边超声波来评估败血性右室功能障碍 (SRVD) 的预后.
确定患有败血症和败血症休克的患者中SRVD的独立风险因素.
为SRVD风险开发一个预测模型 (nomogram).

主要方法:

在ICU的116名败血症和败血性休克患者的前性观察研究.
在ICU入院24小时内用M模式超声波测量三环状平面缩外流 (TAPSE),以定义SRVD (TAPSE <16毫米).
多变量物流回归分析以确定独立的风险因素并构建风险名录.

主要成果:

20.7%的患者患有SRVD. 在SRVD患者中,APACHE II和SOFA分数较高,心脏生物标志物 (cTnI,Mb,CK-MB,NT-proBNP),肌素 (SCr) 和乳酸水平较高,左下心室喷射率 (LVEF) 和血小板计数 (PLT) 较高.
针对SRVD的独立风险因素包括较低的LVEF,较低的PLT,较高的SCr,以及使用北上腺素.
慢性急性肺炎疾病与更长的机械通风持续时间和显著更高的28天死亡率 (41.7%与21.7%) 的趋势有关.

结论:

败血性右心室功能障碍 (SRVD) 与功能受损和早期败血症死亡率增加有关.
降低LVEF和PLT,增加SCr,和诺亚上腺素的使用是SRVD的显著独立风险因素.
基于这些因素的预测名录图可以帮助对SRVD的风险分层.

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